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Author
Topic: When to start meds (Read 2239 times)

Been positive for a year now and my V-Load is at 800... T Cell is 1200...I have Kaiser and my doc said I can start meds anytime I'm ready.... does anyone have any advise on what I should do? Also the guy I'm dating is negative. Would me being on meds help or worries of him getting it be a little less stress full?

Those are awesome numbers. I found out I was poz one year ago, but sure I've been poz since 2001 at least. My last CD-4 was 811 and Vl 27,000. My vl has bounced around from 24,000, down to 6,000, up to 14,000--well you get the picture. My % also bounces around from 27% to 21% back to 26%. I'm not on meds yet. You didn't say what your % is. Two different docs at the HIV practice I go to have given me 2 different opinions about whether to start. Two docs on thebody.com have given me conficting info on whether to start. It isn't that one doc is better. The meds question is just a big debate right now--do you treat above CD4 500? So, I'm debating this issue everyday.

I've talked to several people who didn't need meds for 10, 15, 20 years. I don't want to start too early, but don't want to allow HIV to do unseen damage. If you are ready, then most docs would say you should start. If you know you can adhere to the meds and have access to them, you should start if ya want--even with great numbers. Others may say it starts the clock on possible toxicities and possible resistance.

Regarding infecting your partner, it is unlikely that someone with an undetectable vl would infect someone. Even with your very low vl of 800, it would be a low risk. It depends on the kind of sex you are having. Many would say this is dangerous thinking because you never know if your vl has spiked. If you're having unprotected sex, then it is obviously better to have an undetectable vl.

I wish ya the best making your decision. I often think I should just get the decision over with and just start. Let us know what ya decide.

Those numbers are very good. You probably don't need to worry for now about starting meds. You'll get differing viewpoints from doctors and members of this forum, but the bottom line is that you do it when you feel that you're ready or if/when there is a change that definitely indicates that you have to. The concept of starting even if your CD4 is above the guideline is based on the idea of preventing damage that the virus could cause to your immune system.

Also the guy I'm dating is negative. Would me being on meds help or worries of him getting it be a little less stress full?

are you asking this because in order to decide whether to use protection or not? If that's the case you would need to consider what role you play in the sexual relation. My advise is to play safe regardless, but you may get some different opinions.

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"I have tried hard--but life is difficult, and I am a very useless person. I can hardly be said to have an independent existence. I was just a screw or a cog in the great machine I called life, and when I dropped out of it I found I was of no use anywhere else."

The question about when to start meds is THE biggest unanswered question in HIV treatment. There are official US Guidelines that are just that, guidelines. It can get a little daunting so I recommend you take it one step at a time, don't get overwhelmed but definitely start reading up so that you can make an informed decision.

Consider yourself fortunate to have found out while your immune system is still in good working order. Remember it's important to get tested every few months in order to monitor what's going on as far as disease progression.

Below are links to recent threads that have discussed the question of when to start meds:

Hi Junior, Welcome to the forums. As for meds, you and your Doctor should make the decision together based on your needs.

One school of thought suggests starting meds early to prevent immune system damage. The drawbacks are that the meds are expensive and almost all have side effects of one kind or another. In some rare cases there are reactions that can be serious to each of the meds for a small group of people.

The other school of thought says to wait until you need the meds. Your numbers currently are well above the CDC guidelines for starting treatment. The disadvantage is that your immune system is under attack by the virus. The advantage is that you are keeping your options open for new meds that are not yet available.

As for your partner.......Safer sex and condom use are the only things that are going to protect him. It's important that he learn about HIV and HIV transmission so that he can be comfortable with you. It's great that you are in a relationship. Taking meds each day might shake your partner, so be sure to talk about it before you start doing it. However, if you are able to get your viral load to be undetectable, this reduces your ability to infect someone. The advantage here is that if you should break a condom, or have a blood exposure (say through a cut or accident) there is less virus in your body and thus less opportunity to infect someone. It is NOT a license to have unprotected sex. A Swiss study of heterosexual couples who were trying to have a child concluded that undetectable HIV+ partners were unable to pass the virus when trying to have a kid with a HIV- partner. That is not the same as gay sex.....

For the record, I personally don't like condoms..... but if I were dating someone who was neg we would use them. No if ands or butts.

Meds affect each of us differently, from vivid dreams to urgent bathroom visits. They should not be considered lightly, and certainly don't make your decision based on the advice of anyone online. You are doing the right thing though. Learn as much as you can and then have a conversation with your doc. Most doctors are very good and each has a philosophy of how he or she wants to treat HIV based on what works with other patients. If you don't understand why something is being recommended be sure to ask why. A good doctor will take the time to help you understand his or her recommendation.

Lastly, HIV is a marathon, not a 50 yard dash. It's important to make the right decisions, but you don't have to make it today. Next week will be just fine. You are in excellent health based on the numbers you posted. You can take a month or two to learn and explore and decide what is best for you with your doc. It's also not a bad idea to involve your bf. In particular, you might want to develop a contingency plan in case he accidentally gets exposed. It's possible that if you were to cut yourself badly he might get exposed while rendering aid. In that case he would want to take a post-exposure prophylaxsis (meds) to try to prevent infection. It's not an urgent issue today, but the time to learn how that works is not during a crisis. It's sort of like having a fire extinguisher when cooking with fire. It's just good planning to know what the contingency is.

-Brian

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Don't obsess over the wrong things. Life isn't about your numbers, it isn't about this forum, it isn't about someone's opinion. It's about getting out there and enjoying it. I am a person with HIV - not the other way around.